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Wednesday, December 14, 2011

MiM Mailbag: Baby and OB/GYN internship - HELP!

Hi MiM! First, thank you so much for all of your posts, advice, and stories. I can't tell you how much they have helped me, and I'm sure others.

I'm writing because I have a big decision on my hands and I feel as if the women in MiM might be the only ones who can help me make the decision that is right for me. I am a 4th year med student, in the midst of interviewing for residency. I have long been in love with OB/GYN as a field, but not the atmosphere. So, I decided to dual apply in OB/GYN and family medicine, where the people were more like me, and I could possibly still do OB. My decision to apply in FM was also partially influenced by an intense desire to start a family with my husband, who is a PhD student nearing the end of his degree. We tried to conceive for about 7-8 months as I was in the midst of my surgery clerkship and then my OB sub-Is, and as might be expected my best laid plans to have a baby at the middle/end of 4th year crashed and burned. Even though I was devastated and worried about my own fertility, my husband and I decided to stop worrying about trying to get pregnant until after a few years of residency. Of course, the fertility gods decided to play a little joke on us. As soon as we stopped really "trying" - I wound up pregnant. The baby is due in August of my intern year. I really think I want to do OB/GYN, and I really don't want to lose a year of training, but I'm not sure how I will manage having a baby in intern year. I also don't want to start off on such a bad foot not only with my training but with my fellow residents, who might hate me for 4 years!!

I realize there are a lot of pros and cons to either taking a year off, or starting internship 8 months pregnant and giving birth at the beginning of internship. And, there's also the option of choosing FM over OB, since it is more of a baby-friendly residency, but I'd hate to feel like I didn't choose my preferred specialty because I got pregnant. I guess I'm just hoping to get advice from some of you who are much wiser and more experienced than me in all this. I'm not sure how many people have gone through something like this, but if there are any out there who can give me their words of wisdom, I would be incredibly grateful.

I'm a 4th year med student (I'm 27 and married), born and raised in the northeast, and currently double applying in OB/GYN and family medicine. And I'm 5 weeks pregnant.

21 comments:

First, congratulations! Your situation might seem very difficult, especially with a demanding residency like OB/GYN, but know that other people have done what you are going to attempt.

Disclosure: I am the husband, with a PhD, of a OB/GYN in second year of practice with two boys, currently aged 6 and 3. The older was born right at the end of my wife's 1st year of internship. We're not in the US, so I don't know how well my advice fits with the process of interviewing with programs. FWIW.

I think you should lean toward taking a year off. At the time she became pregnant, we thought a short maternity leave was in the cards. My wife wanted to go back after a 3 month leave, but her sense after our first son was born, the time was just counting down until she would have to go back. She dreaded leaving her son during the day (and night) to be taken care of by someone else. She ended up contacting her program director who was very accommodating and allowed her to take a full year.

She was one of the first to have a baby in her program in several years, so some of her colleagues were less than understanding. Others were very understanding, but you will encounter commentary from people who have decided to put off having kids, or not have kids at all. Some of those people end up needing to go through fertility treatments, and end up reconsidering their earlier remarks. So, it's hard, but IMO worth it.

Forget that this is residency - It's a new job. And I don't think anyone would consider starting a new job in their 36th week of pregnancy. It doesn't make sense for you, your employer or your fellow residents.

I wouldn't take they year entirely off, however. Find a research mentor in ob-gyn at your home institution,and get started right now on a research project in the field you love. Use your energy towards that instead of applications and interviews. If you start it now, you can take time off in the summer for maternity leave and get right back in after that.

You're going to be a working mom forever, so I say get used to it before residency slams you. Taking a year entirely off is going to make it that much harder to make the transition to residency next year. You'll have the upcoming year to work out child care and settle into your new role as a working mom. Trust me, you don't want to be struggling to find the right child care etc during your first few months of internship. You need to be able to go to work and forget about home, knowing it's all taken care of by someone you already know, have worked with and trust implicitly to take care of your child. .

My senior resident when I was an intern had a baby in August of her intern year. It's doable but really hard. You probably don't yet have a realistic idea of how much work a baby is.

If you're doing FM, you might be okay to start an elective or research month after your maternity leave. If you're doing ob/gyn, you should probably take off a whole year. The above person suggested 6 months, but I don't know how doable that is. Would an ob/gyn program allow you that option? I suspect not.

I would be very careful in terms of where you apply and interview for Ob residency. Then, rank your programs very wisely, if you decide not to take a year off. It all depends on where you end up - yes, Ob/Gyn residency is hard, but I know plenty of people that have done it with your same situation. It all comes down to whether your residency program is supportive or not. You may have to give up on the idea of landing in an academic program, and possibly consider more of a community setting so that the patient volume is not as high.

Again, congratulations! I have an almost 7-month-old, and though a lot of hard work, it's a blast.

That said, I did not have him during residency, so take what I have to say with a grain of salt. I am an OB/Gyn going on 5 years in private practice. I was married but did not have children during residency. However, many residents in my program, one of the more demanding ones in the country, had babies, a few during internship (one had hers during her intern orientation week!). I agree with what Peggy said. Take the year off and do something productive with it.

One of the problems with having a baby during residency is that there are limits to the amount of time you can take off each year of your residency. While legally you might be allowed to take a decent amount of time off to spend with the baby (12 weeks, generally), taking that much time will create issues with your residency time-line. However, going back early means being extra sleep-deprived (despite what your friends might tell you about their miracle babies, don't expect to get much sleep for at least 3 months). You'll be a much happier mom and intern if things at home are relatively settled. I went back to work after 8 weeks, and the first couple of months were rough even though I wasn't taking call the first month. I dreaded the nights because I knew I wouldn't get much rest and had a full day in the office to look forward to in the morning. Give yourself a break and do something less demanding for a year.

If you do decide to start internship this coming year, don't worry about your classmates hating you for 4 years. You'll go through a lot with them in those 4 years. In my class of 12, we had 5 babies, lost a brother and 2 fathers, bought and sold houses, matched and didn't match for fellowships, and faced the daunting task of finding real jobs at the end. In the end, you'll all need support from each other. It evens out.

As far as your choice of specialty goes, don't let your decision to start a family be the biggest issue. The bottom line is that FP and OB are very, very different specialties. I went into OB not just to deliver babies but also because I like to operate and am not particularly interested in dealing with chronic disease. I like having continuity of care with my patients, but I also like that I don't have to deal with their diabetes or rheumatoid arthritis. I also like seeing women exclusively because I feel like I've really been able to hone my bedside manner and feel much more connected to them than I ever would to an elderly man, for example. And I like that the much of the obstetrics I do is complicated, high-risk stuff; routine, uncomplicated OB appointments are a nice breather in my schedule,but I would be bored if my day were filled with them. FP is a lot different, and it might be the right specialty for you if you would rather do medicine than surgery, like dealing with chronic medical conditions, want to have a wide range of patient types, and are content managing only low-risk OB patients. Additionally, though FP residencies might be more family-friendly, FP jobs are not necessarily so. I work less than the majority of the family practitioners in my area but also have a thriving, lucrative practice.

I guess my point is that you need to look beyond residency to what your life will look like long-term. Because your adult life so far has been broken up into 4-year chunks, it's easy to have a hard time seeing beyond the next 3 or 4 years, but you'll be shocked how quickly that time goes by and you are suddenly out in the real world finally! And for the record, no matter how bad residency gets, I promise you that life will get better.

I'm a pregnant MS4 as well (although I'm due this March). Just wanted to chime in that a good friend had her first baby in September of her OB/Gyn intern year. She took the standard maternity leave for her program (6 or 8 weeks I believe) and is making it work.

Basically, you don't have to take a year off! From what I hear, there's no "good time" to have a baby, so might as well just go for it!

Also, I would advise going through the match this year (your best chances for a good match are as a US senior) and then sharing your situation with your program after the match.

I agree with Analisa -- think about your long term future more than the next year. You will make the next year work one way or the other. It is hard to be an intern with a new baby. A year off, or starting 6 months late if your program will let you, might be a reasonable option, but you can figure that out after you match. Don't choose your residency based on the next six months -- choose based on the field and the program that makes you feel empowered and motivated and like your future career will be worth the struggles of residency. And congratulations!

I am not yet a resident, still a med student, but I am a mother. And the only advice I'd give you is to consider what kind of mother you want to be. It's hard to understand the full weight of this now, but you will be one of the most important people in your child's life. That is not true for your fellow residents. The needs of a newborn are very different than those of a toddler, and at least in my case I found that my son didnt need much other than me for the first few months. My perspective on life in general changed completely when I had my son, and I had no idea bow being a mother would change me. I didn't even know if I wanted to have children but once he was born and I began taking care of him, I couldnt bear to be away from him. Not all moms feel that way, clearly, but my point is that you have no way of knowing until you are there. I'd just really look at it from all aspects. Because you can't get back time with your babies once it's gone. Just a thought!

There is no perfect time to have a baby in medicine. I had mine my first year in small town, "do it all" family medicine practice--almost harder than internship!

One caveat to consider, and why taking a year off if you can manage it may be the best choice. Be prepared to fall in love with your baby. I wasn't. I discovered that I loved being with him, breastfeeding him, caring for him and really didn't want to miss that. I did go back to work full time at 8 weeks and immediately began figuring out how to restructure my worklife to accomodate exclusive breastfeeding and the kind of parenting I wanted to do. Made it work, eventually, but it was hard. In retrospect, would have taken more time off. Take off as much time as you can.

I do think family medicine will likely be more supportive. I'm residency faculty and women residents having babies is just part of life for us. We allow "parenting electives" and I've helped new moms work out "breastfeeding electives". These do include academic content but are things you can do with baby. There can be clinic requirements, however, since you can't be away from clinic for more than 2 months and stay on track to take Boards. And I'm a family medicine doc who chose FM because I love OB but am NOT a surgeon--OB/Gyn is really a surgical specialty. (And I really didn't want to give the newborns to the pediatricians--mother/baby couplet care is the coolest thing I do!)

Good luck with your decision. Whatever decision you make will be the right one for you and you and your husband will make it work. Your baby will feel loved and wanted and it will all be fine.

There is no perfect time to have a baby in medicine. I had mine my first year in small town, "do it all" family medicine practice--almost harder than internship!

One caveat to consider, and why taking a year off if you can manage it may be the best choice. Be prepared to fall in love with your baby. I wasn't. I discovered that I loved being with him, breastfeeding him, caring for him and really didn't want to miss that. I did go back to work full time at 8 weeks and immediately began figuring out how to restructure my worklife to accomodate exclusive breastfeeding and the kind of parenting I wanted to do. Made it work, eventually, but it was hard. In retrospect, would have taken more time off. Take off as much time as you can.

I do think family medicine will likely be more supportive. I'm residency faculty and women residents having babies is just part of life for us. We allow "parenting electives" and I've helped new moms work out "breastfeeding electives". These do include academic content but are things you can do with baby. There can be clinic requirements, however, since you can't be away from clinic for more than 2 months and stay on track to take Boards. And I'm a family medicine doc who chose FM because I love OB but am NOT a surgeon--OB/Gyn is really a surgical specialty. (And I really didn't want to give the newborns to the pediatricians--mother/baby couplet care is the coolest thing I do!)

Good luck with your decision. Whatever decision you make will be the right one for you and you and your husband will make it work. Your baby will feel loved and wanted and it will all be fine.

I'm a current OB resident and I had a baby a few months back in my 3rd year. I would strongly advise taking the year off. I think it's going to be very disruptive to your intern year which will be the foundation for the rest of your residency.

When I came back from maternity leave after 6 weeks it wasn't just hard to leave my child, but I was extremely rusty in the OR/on the floor, slow, clumsy and so tired - and this is after being a resident already for 2 years. No one really has much sympathy, which is just the way it is. I also wasn't sleeping well through the night which never helps. I was also behind my peers in my year and it took a bit of time for me to catch up. In the end, it's fine but I think it's best for your training to take the year off.

As far as having the time to use for maternity leave, your program will likely work it out regardless. I just don't think you will be doing yourself a favor by taking that kind of time off so early in your intern year.

We had someone who went through a similar situation and took a year off - and is now reinterviewing. I don't think it's held against them at all.

Congratulations! Your post brings back memories. I'm from the NE and am currently training in the NE. My husband (resident) and had our daughter at the very end of med school. I was planning on taking a year off an then going into obgyn. I ended up applying to both family med and ob during the year I stayed home with our baby.

I stayed home for a year (hate saying that I took a "year off" because I worked hard that year!) because we wanted to space our intern years. I was ambivalent about taking a year off and thought I could just jump back after 8 weeks away but I'm so happy with my decision to take a year.Former posters are right- I believe no one truly knows the demands of a baby until you actually have one. I also developed certain goals after I had her (exclusive breastfeeding) that would have been very difficult to do if I'd gone back immediately. Having a full year allowed me to fully enjoy being a mom. Cliche but true.. I found my play date pals, made homemade baby food from a garden that I grew and supported my husband in his internship. I never want to be a full time stay at home mom (*yawn*) but I truly appreciate having that year to get back into shape and bond with baby.

I'd developed a strong interest in women's health in med school, even heading up the ACOG student group. I also loved surgery and the intensity of the OR. However, my desire to have flexibility with my career and diversity in patient care lead me to choose family medicine. I love the continuity I have with my patients and enjoy the wide breath of knowledge that comes from family medicine training. Residents from my program graduate to do outpatient, be hospitalists, OB providers (a few have even gone to ob fellowships for c/s training, etc.), geriatricians, sports medicine docs, urgent care, etc. The flexibility is amazing and the job market is booming right now. I'll have more than adequate training to catch babies when I'm done however, I'm finding that has become a little monotonous and am excited about all the other areas of medicine that I've developed interests in.

My internship year was intense, easily as many hours as an ob intern however my second and third years are definitely better than my ob colleagues, many of whom have 6 months of labor floor per year and at least 8-12 weeks of night float per year. This makes a huge difference especialy when you have a toddler at home and are considering another baby.

My advice is to take a year. See if and how your life and goals are affected by your baby. Good luck with your decision and baby!!

Based on the responses above, you could do either and be ok. It sounds like your husband and family would be supportive regardless. On the other, you're only 27. Why not take a year since you have the time? It'll give you some time to figure out childcare and a routine without also having to be an intern at the same time. 27 is not old, and your baby will only be a newborn once, so if you can take the time, why not do it and enjoy it.

Wow, thanks for sharing your situation, and thanks to everyone for their comments. And Congrats!

I'm 27 and graduated med school this summer. I took a 'year off' to do research while my husband finishes his fellowship (recently married!), that way we could move off together to our next place in life (for me happens to be Family Medicine, also because I love OB but I want to be able to take care of all types and maybe work overseas)...

We haven't decided how to manage bringing on a new family, but I met with my doctor today who suggested that we start trying!! Long story short, I may have trouble conceiving, so her suggestion is to start trying so if I need more help, we know sooner rather than later. (And from your story, I can tell that who knows what will happen? Best laid plans...)

But what if I did get pregnant- and then started intern year?

So I appreciate everyone's advice and you for sharing your situation. I don't think I could take another year off- but I may regret not trying to conceive if we find out so much later that I can't! You'll have to look at all the sides or your situation, weigh it with what you want, hope for, dream about, and together with your husband you can't make the wrong choice here. You'll make a very good choice if you spend the time with it. And pray- I really believe that helps.

On taking a year off- if you have a mentor or adviser at your school, they may help you make that decision. A year off is not a bad thing, especially if you use it to pursue something that is valuable to you and is a benefit to you professionally. My current work is fascinating to me, and going into FM I think gives me a real edge and great perspective about what I can do in the future. (A publication doesn't hurt either!)

Congratulations! Lots of good advice above, some of which I will echo. No matter which specialty you choose, If you are financially able, TAKE THE YEAR. No, really. Take the year. If you do not ( I believe) you will wish that you did. Do see if you can do research during that time because all residency programs tend to require research, so you can get that under your belt during your own time and stay within the academic loop, so to speak. If you do choose OB as a residency, your intern year is the most important for fundamental training, and you will want to be on your "A game." (Very tough to do with a newborn.) I am not saying that it cannot be done, but it would be a really difficult course to follow. All the best in the route that you choose and with your pregnancy!

Take as much time off as you can. I am currently nursing baby number 4 who is 6 months old. My oldest is 6. I am working part time in clinical research. I feel babies do need their mothers and I have enjoyed the first five years of all my childrens' lives while working part time in clinical research, publishing, surgical assisting and teaching. I plan to start specialist training next year. My husband and family are very supportive. It has been hard to find a balance but I am sure you will find what suits you and your family will be just fine. I would also say take time off to recuperate. Mothers physically and mentally take on a lot of responsibility. It is exhausting and you will be run down at times. Don't forget yourself. This was driven home to me when I had bacterial meningitis a few years ago and was admitted suddenly to hospital for a few weeks. The number of people I had to rally around to replace myself at home and at work shocked me (6). Good luck. Enjoy your new baby. It's a very very special time.

I would like to add that it can be done if you don't take time off. There was a colleague in my peds class who had a baby right after starting internship, and she came back after 6 weeks. It ate up all her vacation time and it was hard, but she made it work. So it's up to you, but I really do think that you can make it work if that's what you choose. I had a baby in my last year of residency. I had to establish breastfeeding with a near term premie, and it was really hard. I had to take 8 weeks off and make up 2 weeks, but I did it, and my son and I are no worse for the wear.

Also, in terms of FP vs. OB/gyn, you really need to think through this one in terms of the rest of your career. Lots of FPs I know don't do any OB because of malpractice and lifestyle issues, and the practice scope is so different.

I was in your same situation- tried for a baby 3rd year, actually told we may never concieve, then spontaneously concieved in the middle of 4th year and had my baby 3 months into intern year! I did peds, not OB/gyn. It was very hard, but doable. I think infancy is the LEAST important time to be with your child during the day- anyone can feed and bath him, and he has no memory of it. Now that my son is a toddler, I'm glad to be working part time and have lots of time to spend with him and we are very close. However, my fellow residents were already pissed when they saw I was so pregnant when starting residency, and you need their support as a resident, especially as an intern! It took them a while to see I was not a slacker (quite the opposite, working in clinic and completing my pts WHILE IN LABOR!! despite barely being able to walk and being in severe pain). And I only got 4 weeks off, which completly sucked! After giving birth I cried a lot, wiching I could have taken off the year, so if that is a real option for you, you might consider it. But if you go for residency, you can do it. All working mothers learn to become super woman!

I'm in my 3rd yr of ob residency and had a baby intern year. Was it tough? Yes, very. But I was able to make it work. I do think that taking a year off would have been a good idea, so if you have that opportunity, take it. Good luck!

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